Early Placement of Postpartum Hemorrhage control Devices improves Outcomes: Study
Researchers have found similar outcomes in terms of blood loss, transfusion rates, and device failure in a study comparing two postpartum hemorrhage-control devices; intrauterine balloon tamponade and vacuum-induced devices. However, earlier placement of either device significantly reduced the need for transfusion and the likelihood of device failure, highlighting the importance of timely intervention. The study was conducted by Shields L. and fellow researchers published in Obstetrics & Gynecology journal.
The research was conducted under a quality improvement initiative to improve postpartum hemorrhage management. Data were collected prospectively from August 2022 to February 2024, during 123,292 deliveries, of which 5,931 (4.8%) had postpartum hemorrhage. Hemorrhage-control devices were utilized in 666 cases (11.2%), intrauterine balloon tamponade being used in 300 cases and vacuum-induced devices in 366 cases. The key outcomes measured were quantitative blood loss following device placement, requirement for packed red blood cell (RBC) transfusion, transfusion of 3 or more RBC units, and failure of the device.
The research employed a standardized three-stage postpartum hemorrhage response protocol. Hemorrhage-control devices were used in stage 2 or 3 of the protocol. Quantitative blood loss was quantitated, and the proportions of blood transfusion, utilization of 3 or more RBC units, and device failure were compared.
Key Findings
The median quantitative blood loss during device placement was 194 mL (67–440 mL) for intrauterine balloon tamponade and 240 mL (113–528 mL) for vacuum-induced devices (P=0.40).
Packed RBC transfusion rates were 59.7% for balloon tamponade and 50.0% for vacuum devices (P=0.08).
3 or more RBC units transfusion was 27.0% of tamponade cases and 24.9% of vacuum device cases (P=0.53).
Failure rates for devices were 7.7% for tamponade and 8.5% for vacuum (P=0.70).
Preceding device insertion at blood loss of 1,000–1,499 mL decreased RBC transfusion rates (39.1% vs 70.3%, P<.001), requirement for 3 or more RBC units (13.7% vs 38.1%, P<.001), and device failure (3.4% vs 12.9%, P<0.001).
The study authors concluded that prior placement of hemorrhage-control devices during postpartum hemorrhage greatly reduces blood transfusion needs and device failure. Both intrauterine balloon tamponade and vacuum-induced devices worked, but timing is all about maximizing outcomes.
Reference:
Shields, Laurence E. MD; Klein, Catherine MSN, RN; Torti, Jennie MPH; Foster, Mindy MSN, RN; Cook, Curtis MD. Effectiveness of the Intrauterine Balloon Tamponade Compared With an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device for Postpartum Hemorrhage. Obstetrics & Gynecology 145(1):p 65-71, January 2025. | DOI: 10.1097/AOG.0000000000005770
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